La adherencia al tratamiento antirretroviral en pacientes con VIH/sida y estrategias para su optimización. Un enfoque integrador = The adherence to antiretroviral therapy in patients with HIV/AIDS and the strategies for its optimization: an integrated approach / Miriam Cordero Vargas

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Bibliografía: p. 33

INTRODUCCIÓN. La producción científica demuestra que es necesaria una adherencia al tratamiento antirretroviral (TAR) del 95 %, que perdure en el tiempo, para conseguir reducir la carga viral plasmática (CVP), aumentar los linfocitos CD4, disminuir el riesgo de infecciones oportunistas y reacciones adversas. La valoración y fomento de la adherencia al TAR es, por lo tanto, un factor clave y prioritario en la práctica asistencial. Para ello existen diversos instrumentos para conseguir optimizar la adherencia y disminuir las complicaciones asociadas como la morbilidad, y así aumentar la calidad de vida de los pacientes con VIH/sida.
OBJETIVOS. Analizar la adherencia al TAR y las diferentes estrategias utilizadas para su optimización en pacientes con VIH/sida.
MATERIAL Y MÉTODO. Diseño: revisión bibliográfica. Se realizaron dos búsquedas en 4 bases de datos distintas, una para revisar los artículos que analizaran la adherencia al TAR en pacientes con VIH/sida y otra para revisar los artículos que analizaran las estrategias que optimizan la adherencia al TAR. Los resultados se procesaron mediante el programa Microsoft Excel 2007, y el análisis estadístico se realizó mediante el programa SPSS 15.0.
RESULTADOS. En lo referente a la adherencia al TAR en pacientes con VIH/sida, un 64.19 % de ellos presenta una adherencia óptima al tratamiento. El 40.74 % de los estudios establece que la intervención multidisciplinar aumenta considerablemente la adherencia, y ella la sigue, con un 25.9 %, el apoyo social-familiar-psicológico.
CONCLUSIONES. Uno de cada tres pacientes analizados no presenta una adherencia óptima al TAR. La intervención multidisciplinar se configura como la estrategia de mayor eficacia para optimizar la adherencia al TAR.

Introduction. Scientific production shows that adherence to 95% antiretroviral therapy (ART) is necessary, lasting over time, to reduce plasma viral load (CVP), increase CD4 lymphocytes, decrease the risk of infections opportunists and adverse reactions. The assessment and promotion of adherence to ART is therefore a key and priority factor in the practice of care. To do this, there are various tools to optimize adherence and reduce associated complications such as morbidity, and thus increase the quality of life of HIV/AIDS patients.
Objectives. Analyze adherence to ART and the different strategies used for optimization in HIV/AIDS patients.
MATERIAL AND METHOD. Design: bibliographic review. Two searches were conducted in 4 different databases, one to review articles analyzing ART adherence in HIV/AIDS patients and another to review articles that analyze strategies that optimize ART adherence. The results were processed using the Microsoft Excel 2007 program, and the statistical analysis was performed using the SPSS 15.0 program.
Results. When it comes to ART adherence in HIV/AIDS patients, 64.19% of them have optimal adherence to treatment. 40.74% of studies state that multidisciplinary intervention significantly increases adherence, followed by 25.9% of social-family-psychological support.
Conclusions. One in three patients analysed does not have optimal adherence to ART. Multidisciplinary intervention is configured as the most effective strategy to optimize adherence to ART.
Objectives. The objectives were: 1) to define the concept Coexistence with a chronic process; 2) Design a scale of measurement of the degree of coexistence in patients with a chronic process, and in particular with Parkinson's disease.
Methodology. Two methodological steps were carried out. Regarding the first, an analysis of the Conhabitation concept was carried out with a chronic process, through Rodgers' evolutionary method. The second methodological step was the design of the scale, through the guide proposed by DeVellis.
Results. Through concept analysis, coexistence with a chronic process was identified as a complex, dynamic, cyclical and multidimensional process composed of the attributes of Acceptance, Confrontation, Self-Management, Integration and Adaptation. As for the results of the scale design, a self-fulfilling measure was developed, with five response options, Likert type and 27 items.
Conclusions. The scale designed, is an innovative measure of potential clinical interest that allows to identify which factor or factors make the person live better or worse with the disease and, consequently, intervene in a comprehensive way, according to the needs individual individuals of each person.